Permit (65) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT ` ` _ Permit PLM2016-00498
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439WI' igai Date Issued: 11/08/2016
T f aF 9 �� Parcel: 2S102CC09100
Jurisdiction: Tigard
Site address: 13553 SW PACIFIC HWY
Project: DDHK, LLC Marijuana Facility Subdivision: 2008-058 PARTITION PLAT Lot: 2
Project Description: Site utilities for a new 2,997 sq ft retail building. 1/10/17,REPRINTED to change contractor
Contractor: MALMEDAL ENTERPRISES INC Owner: DDHK VENTURES LLC
PO BOX 207 12604 SW 60TH CT
BANKS, OR 97106 PORTLAND, OR 97219
PHONE: 503-324-0759 PHONE:
FAX: 503-324-0580
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 11/08/2016 $18.76
Specifics: 1 ea Manholes 11/08/2016 $18.76
12 If Sanitary Sewer 11/08/2016 $62.54
Type of Use: COM 228 If Storm Sewer 11/08/2016 $137.58
Class of Work: NEW 171 If Water Service 11/08/2016 $100.06
Type of Const: 1 Plan Review 11/08/2016 $84.43
Occupancy Grp: 1 12%State Surcharge- 11/08/2016 $40.52
Stories: Plumbing
45 Misc Administration Fee 01/10/2017 $45.00
Total $507.65
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ►• ' .• Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or.'ect questions to c ,. . calling 503.232.1987 or 1.800.332.2344.
I sued By: �1P0 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Afati."
City of Tigard • COMMUNITY DEVELOPMENT DEPARTME
N
Request for Permit Action JAN o 20,_
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • wwv(tiffavolevar gov
15 Una,
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: I
INVOICE TO: (Business or Individual) /�-
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
ig REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: i LIL1 Z..6(6
Site Address or Parcel#: / ? 'j f .�i/l! U
a ? 7z
Subdivision Name: Lot#:
EXPLANATION: :a Frr v —. Is cP6a:Ai t.�i
, �D '/wok t `Oleo-OM/41Z
I) N., Lrw�/J1 r�
Signature: Date: ///6) /7
Print Name: ft-t_ bo. A v�
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: _ Date By
Refund Processed: Date By Invoice Processed: _ Date By
Permit Canceled: Date By Parcel Tag Added: Date By
1:\Building\Forms\RegPermitAction_092314.doc
Jan 06 2017 07:07AM HP Fax page 1 i� fit ''
L ,
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT.
11 5 It Request for Permit Action
TIiiARD
13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www•tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
y Phone: 503-718-2439 Fax: 503-598-1960 OwnerTigardBuildingPerrnits@tigard-or.gov
Applicant FROM: ❑ ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (B°siness or andividiia+)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
0 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ONPERMIT (do not cancel permit).
Permit #: eLpi4 r` � - 0cci9g
Site Address or Parcel #: i-5SS3 -'v IttLtF/ `4 , I f
Project Name:
Lot#:
Subdivision Name: f
Q _ , V-T ( 't'I 7 fr - /e- tO/t/l j �'c-- P
EXPLANATION: ► �J/ r/
ate: r e,c--- i 7
Signature:
Print Name: A -
Refund Policy (IMP -t. -L PLUM gI N do)
1. The city's Community Development Director,Building Offieeii l or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 8O%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Records: Date _BY
Route to Sys Admin: Date By Invoice. Processed: Date By -
Refwtd Processed: Date By � Parcel Ta added: Date � BY
Permit Canceled: Date BY g'
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00498
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/08/2016
L f Ctift• Parcel: 2S102CC09100
Jurisdiction: Tigard
Site address: 13553 SW PACIFIC HWY
Project: DDHK, LLC Marijuana Facility Subdivision: 2008-058 PARTITION PLAT Lot: 2
Project Description: Site utilities for a new 2,997 sq ft retail building.
Contractor: IMPERIAL PLUMBING INC Owner: DDHK VENTURES LLC
1954 SW 35TH ST 12604 SW 60TH CT
GRESHAM, OR 97080 PORTLAND, OR 97219
PHONE: 503-515-1616 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 11/08/2016 $18.76
Specifics: 1 ea Manholes 11/08/2016 $18.76
12 If Sanitary Sewer 11/08/2016 $62.54
Type of Use: COM 228 If Storm Sewer 11/08/2016 $137.58
Class of Work: NEW 171 If Water Service 11/08/2016 $100.06
Type of Const: 1 Plan Review 11/08/2016 $84.43
Occupancy Grp: 1 12%State Surcharge- 11/08/2016 $40.52
Stories: Plumbing
Total $462.65
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344.
Issued By: / .-rmittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
Received
City of Tigard y //(ti PermitNo.: IRj.j�---(301117 y i7
ED Date/ li x'"/
IN 'I 13125 SW Hall Blvd.,Tigard,OR . EN• Plan Review
• Phone: 503.718.2439 Fax: 503." g1. Other Permit No.: , /
Inspection Line: 503.639.4175 Date/By: (S s ,_��, / C �
Ins
TI G A R D P s GC % 9 0$ Date Ready/By: //� Juris: ® See Page 2 for
Internet: www.trgard-or.gov i G Notified/Method. e-k 7=4; Supplemental Information
TYPE OF WORK e-riGAata /' INJ
FEE* SCHEDULE
�*New construction L L ii. 0I\`S 0" For special information use checklist
�I Description Qty. Ea. Total
❑Addition/alteration/replacement J •kr: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 'Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /3 S 3 f0 P 1,['c` Catch basin or area drain ,�� 18.76 / �)
City/State/ZIP: Drywell,leach line,or trench drain 18.76
y / < C)-.-Ci O 1�
q Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 44/;i�1 Manufactured home utilities 50.03
Cross street/directions to job site: A,,,p_ ._ 4/k., Manholes _t/1 18.76 iet:.]
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: )vf 1_64" Page 2 ...0)%,51/ ;�
Storm sewer(no.linear ft.:21. )v" I Page 2 _4,7,..-1-%,,,.•
Water service(no.linear ft.:I1 I ) r Page 2 1'
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: _ 2,7 6 2 ' 9r 0C Backflow preventer 31.27 100,1`'L
DESCRIPTION OF WORK r Backwater valve 12.51
/� / 6' /,f' Clothes washer 25.02
AJ-e..-e..tv �•�'--Ai I ,t c(�"l A C% Dishwasher 25.02
( Drinking fountain 25.02
Ejectors/sump 25.02
4N gii PROPERTY OWNER I 0 TENANT Expansion tank 12.51
ame: 1 elf K (/.n L/(� i L L Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
4 Address: pc) 702 Garbage disposal 25.02
City/State/ZIP: . 7 6 f` Hose bib 25.02
LI
Phone: 3 ) v Fax:( ) Ice maker 12.51
0 APPLICANT 'CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
�� Primer 12.51
�";, Contact name: � efo L/ Roof drain(commercial) 12.51
Address: if',
( Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(52)3) G 5'(;,--U S',' Fax::( ) Tub/shower/shower pan 12.51
'- Urinal 25.02
E-mail:
rt cin II"? fit/,t. � /`eu.( / c.0 Amt
Water closet 25.02
CONTRACT94 A '
/�
Water heater 37.52
Business name: /M Pt/2,H L Pt u i 61,0ke Ilk- WaterP�P� l�1 m DWV 56.29
Address: Other: 25.02 339.y
City/State/ZIP: Subtotal 474,g
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 005 $:j /a�//'f Plumbing Lic.no.:P�7l‘ � Plan review (25%of permit fee) {-,ti`.
l�l ri State surcharge(12%of permit fee .. 4061
Authorized signature --- TOTAL PERMIT FE . ...t-r-9-.--7-3.
Print name: Date: 7/7 7/� This permit application expires if a permit is not obtained within 180 days
lei rs.`7 after it has been accepted as complete.
C/ *Fee methodology set by Tri-County Building Industry Service Board.o
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) YCA • (o--
or
So
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 1 -y - 7,201 and greater $327.54
Sewer-each additional 100' 37.52 /`
Water Service-1st 100' / 62.54 6,2 y-z, Medical Gas Systems:
Water Service-each additional 100' J 37.52 31,S Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 fp
� (,.�-), "'�.„, $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' a 37.52 "7,5,eq $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
AOC,ie
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tallThras defined in OAR918-780-0040.
❑
Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagra'
4,>
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley _
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must beaid before the
Water Extractor p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13553 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2016-00498
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections are complete, site plumbing final - approved
2. 1 1/4" Apollo DC, model DCLF4A, for irrigation, located at N.E. corner of bldg. - ok
with test
Violation Summary:
Inspector Contractor